Rural hospitals present important healthcare providers to remoted communities throughout america; for many individuals, they’re actually a lifeline. However these establishments face important challenges—from workforce shortages to monetary hardships—that threaten their means to proceed serving their communities.
A latest research famous that greater than 700 rural hospitals throughout america are at the moment prone to closure because of monetary hardship.1
In response to this rising disaster, Microsoft’s Rural Well being Resilience Program empowers these important organizations with know-how and coaching to develop into extra resilient and enhance monetary viability. This initiative is a part of our broader Microsoft Elevate dedication, which focuses on offering entry to AI instruments and abilities to create alternative throughout numerous sectors, together with healthcare.
We’re proud to announce that the claims denial navigator is obtainable now within the GitHub Fashions catalog—a free, AI-powered instrument developed by Microsoft Companions and rural well being leaders, from our Microsoft’s Rural Well being AI Innovation Lab (RHAIL).
This instrument provides hospitals a strong strategy to deal with denied claims extra effectively—and obtain acceptable reimbursement for his or her providers. It’s obtainable now in GitHub for any healthcare supplier, from small rural clinics to giant city well being programs.
Enhancing monetary outcomes with less complicated denied claims decision
One of many best monetary hurdles for hospitals entails denied insurance coverage claims, and for small hospitals, the fallout is especially extreme. Whereas many denied claims are ultimately authorised, the common value of managing denied claims for a small hospital is estimated at USD330,000 yearly, with the method of resolving them consuming valuable time and assets, slowing money circulate and inflating administrative prices. What’s extra, statistical evaluation reveals that rural hospitals have a denial price of 18%, far increased than the ten% price for city hospitals.2
Right now, the supply of the claims denial navigator adjustments this image.
What’s the claims denial navigator?
The claims denial navigator streamlines decision processes for denied Medicare, Medicaid, and business insurance coverage claims. It gives suggestions for the best actions billing employees can take to resolve denied claims and learns from their actions and suggestions to enhance its suggestions over time. This free instrument is safe (no knowledge leaves the group) and easy to deploy, making it straightforward for hospitals to appreciate important advantages, together with:
- Sooner income circulate: Much less effort and time spent on analysis and determination of denied claims.
- Improved employees proficiency: Expedites onboarding of latest billing employees and continued skilling.
- Higher monetary outcomes: Extra claims resolved at a decrease value.
“Southern Coos Hospital & Well being Heart lately transitioned [to a new] digital well being document system. As a part of this course of, we prioritized an accelerated rundown of our legacy system. Our income cycle staff leveraged the denial administration app to assist this effort, decreasing the legacy rundown timeline by a number of months. Participation within the RHAIL program additionally demonstrated the worth of growing low-cost, focused purposes in key operational areas like income cycle.”
—Scott McEachern, Chief Info Officer at Southern Coos in Bandon, OR
“After a long time of working to enhance healthcare entry and fairness, I’ve seen how systemic monetary pressures threaten the survival of rural hospitals. The claims denial navigator represents a essential step ahead—an AI-powered instrument that empowers rural suppliers to get well income extra effectively, strengthen their monetary footing, and proceed delivering important care to their communities,”
—Dr. Jim Weinstein, Senier Vice President Microsoft Well being—Innovation and former Director of the Dartmouth Institute and CEO of Dartmouth Well being
We’re partnering with the Texas Workplace of Rural Clinics and Hospitals (“TORCH”), who will assist their members in deploying and measuring success of the claims denial navigator. The Washington State Hospital Affiliation there’s making certain its members are conscious of and have entry to the useful resource and can present alternatives for members to share experiences with the instrument. Slalom, our design and growth consulting accomplice, may even assist broad adoption via its Public and Social Impression staff.
Trying forward
The claims denial navigator is only the start. RHAIL is already engaged on future collaborations to construct resilience, enhance monetary viability, and supply equitable entry to high-quality healthcare for all communities.
At Microsoft, we perceive the significance of rural well being in communities throughout America. By way of our Rural Well being Resilience program, we’re dedicated to serving to them thrive.
Empower your group via AI innovation and cybersecurity instruments by exploring all of our Rural Well being Resilience program’s choices for rural well being organizations.
1 Pennsylvania Workplace of Rural Well being, 703 Hospitals at Danger of Closure, State by State.
2 Rural Well being Methods to Optimize Utilization Evaluate and Denials Administration, February 2025.
Erin Burchfield leads a staff centered on strategic progress initiatives inside Microsoft Elevate, which focuses on offering entry to AI instruments and abilities to create alternative throughout numerous sectors. She leads Microsoft’s Rural Well being Resiliency Program, supporting rural hospitals in america to enhance their cybersecurity posture, make the most of AI, and develop into extra technologically resilient.
